It’s a slow news day. Day two after transfer is creeping slowly along like most days between now and the blood test will.

That means its time for me to get all nerdy on my readers again and explain a bit more of the science behind this miraculous process. In previous posts I’ve described the role of lupron and estrogen. Both hormones are pretty awesome and make it possible for Blastocyst Blob to grow into a bonafide baby. However now an even more captivating hormone is in play.

Prodigious Progesterone.

If all the IVF hormones and drugs were characters in the movie Grease, Progesterone would be Danny Zuko. It’s one slick dude and most definitely the leader of the pack.

Image: John Irving Via Flickr

For the last several weeks my reproductive system has been in a holding pattern. The lupron injections stopped ovulation. The estrogen patches and pills helped build the uterine lining. Theoretically this could have gone on forever with no effect or change, but of course that’s not the point.

Once the lining ultrasound scan and blood work checked out okay we added our final drug, progesterone. That is when things really heated up in this radical game of chance.

Blob needs a perfectly prepared endometrium in order to nestle in and grow into our bundle of joy. For this to happen, my lining must be receptive and ready for him to implant. Amazingly, there are only a few short days in which Blob and the endometrium can make a love connection. Progesterone starts the clock on this critical time frame.

Progesterone changes the lining, making it slightly thinner and replacing the triple layers seen on an ultrasound with a white cloud-like appearance. Whether in natural pregnancy or through assisted reproduction, progesterone gets in the game 5 or 6 days before implantation begins. Administration of progesterone for IVF is timed when ovulation when ordinarily occur in a natural cycle. In a natural cycle it is secreted by the corpus luteum and eventually by the placenta.

During the five and a half days prior to transfer of the embryo, progesterone helps the endometrium develop tiny little finger-like structures called pinopodes. Those pinopodes typically appear 5 to 7 days following ovulation, right around the time the blastocyst hatches from its shell and begins to excrete enzymes which will allow it to attach. The fingerlike pinpodes are only present for two to three days and it is theorized they must be present for implantation to occur.

If you research implantation, you will find many studies show the window can be as much as 6 days or even more, but its solely a function of not being able to pinpoint exactly when all these necessary steps take place. The true implantation window is likely equal to the life of the pinpodes. This time frame has to be matched with a blastocyst that is hatched, healthy, and ready to go.

If the blastocyst is too slow to develop, game over.

If the blastocyst develops, hangs out, and then dies before the lining is receptive, game over.

Image: Mykl Roventine via Flickr

This sliver of an opening is occurring inside me right now. For me to meet Big Blob someday, at this moment I need to have pinpodes that are closing in on Blob who has re-expanded and continued to grow to the point where he is burrowing in and about to excrete enzymes.

If Blob doesn’t make it, the absence of HCG will tell my body its time to begin the process of shedding my lining in which would normally occur in a week or so.

Isn’t it mind blowing that anyone ever gets pregnant?

Isn’t progesterone one bad mamma jamma?

Progesterone for IVF is also like the young and spunky Travolta character in that it can be a little oily.

Image: Thom Wong via Flickr

There are three ways to administer progesterone, by pill, vaginal suppository, and injection. The pill metabolizes inconsistently so only the suppositories and the injectible are used in IVF. The injectable is progesterone suspended in oil and astutely called “progesterone in oil” (PIO). I am taking both because my doctor likes to hedge his bets.

The PIO injections are hands down the most painful in IVF. Intramuscular injections, progesterone shots cause bruising and soreness in the hip area where administered. Many women need to ice the area prior to the shot and comfort the target area with a heating pad and massage after. This process helps alleviate some of the discomfort.

Side effects of progesterone are pregnancy symptoms which are experienced when taking the hormone at high levels whether pregnancy occurs or not. This totally messes with the mind of a hopeful momma wannabe as she ponders continuously;

Is it pregnancy or progesterone???

These side effects include bloating, abdominal pain, nausea , breast tenderness, headache, drowsiness, mood swings, irritability, and vaginal discomfort. Of all the drugs it mimics pregnancy the most, but for me at least it seems to balance the effects of estrogen and I feel better when I am on it.

Outside of its reproductive role, progesterone boasts many other riveting attributes. Progesterone relieves water retention in cells which is why some of my bloating from other drugs subsides for a short time when I begin taking the hormone. Most interestingly, progesterone inhibits the breakdown of the feel good neurotransmitter serotonin. As a result, the hormone has been proven to successfully treat addictions like nicotine and cocaine. The hormone is also being tested as a treatment for multiple sclerosis, certain skin disorders, and cancers.

Finally, it appears a reduction of progesterone is associated with cell death and scientists theorize administering the hormone could slow the signs of aging. Yes! Its a well deserved upside for those of us who have been on and off the hormone for years.

Our eggs may be getting older and we may not easily get pregnant, but at least we get to sip more than our share from this hormonal fountain of youth.

At least there is that.

Image: Sarah Veale via Flickr

UPDATE- This post was written yesterday during my long wait at the airport. Today we are three days past transfer so Blob should already be nestled in tightly. Now he should be dividing into two layers that will eventually become the baby and placenta. Unless of course he divided into two identical twins or is a little on the slow side. I am feeling a little crampy and bloated which could be a good sign. Unless its just the progesterone.

It will be at least another day and probably more before Blob is producing enough HCG to turn a pregnancy test positive.

Not that I am thinking of testing…. I am not thinking about that at all. Nope. Not happening. Really. It’s not. Never.

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9 thoughts on “Prodigious Progesterone”

BOTH?! Ugh. That’s the worst. The butt pain AND the nasty vaginal crap. Usually you can get away with one or the other. I was on both for my last cycle (19 weeks pregnant now, so not so bad in retrospect!) and I hate both. But, fingers crossed that it works!

i came across your blog looking for other information during my panic search as am going to be doing my FET next friday but my lining is not where we were hoping it would be. it’s good enough for our RE to say that we can move forward but i’m anxious because it’s not in the optimal number thickness we were told it should ideally be. so i was doing a search online for endometrin lining issues with IVF and came across your blog and just wanted to say thank you for writing this and for being so detailed. i’m praying that with my 6.6 lining that i have that i’ll have the pinpodes and that hopefully this time around will work. this will be our 4th IVF but our 1st one with this new doctor we are seeing in Colorado. i am also going to be starting the double dose of progesterone, injections of the oil and the suppositories. the injections were horribly painful for me in the past so i’m not looking forward to this but this is my protocol. anyway, thank you again. here’s to hope.